wolverhampton city pct copd & asthma benchmarking data...wolverhampton pct’s 2009/10...

West Midlands SHA report Page | 1

Wolverhampton City PCT COPD & Asthma Benchmarking Data

Dr Colin Gelder*, Sandy Walmsley

*, Paul Dodd ^, Dr Matthew Coates

+

*Respiratory Leads NHS West Midlands

^Programme Specialist NHS West Midlands

+NHS Strategic Analyst, Novartis Pharmaceuticals UK Limited

May 2011


1.0 Purpose of Report

We present a report on COPD and Asthma for Wolverhampton PCT. The purpose of the report is to provide up to date data

illustrating the current costs to the PCT of COPD and Asthma, the variations in practice between (1) the PCT and other PCT in

England, (2) between the PCT and other PCT in the West Midlands, (3) between the PCT and other PCT with a similar level of

deprivation, and (4) to demonstrate the variation on admission rates between individual practices. The report is intended to stimulate

discussions around service improvement and QIPP alignment. The savings that would be achieved by QIPP alignment have been

calculated, as have the number of Practices that would have to be supported to reduce admissions to the QIPP target.

2.0 Methods

i. Data sources

The prevalence data used in this report were obtained from the NHS information Centre, QOF practices and prevalence 2009/10. The

hospitalisation data were obtained from Dr Foster and HRG4 codings were used throughout. All data refer to financial year 2009/10.

ii. Calculation method

Hospitalisation parameters were calculated a per 1000 population basis throughout this report to allow a relative comparison to SHA

and National means. The per population basis was chosen ahead of a per register size basis to eliminate variations in the reported

disease prevalence, which are expected to fall well below the real prevalence figures.


3.0 Executive Summary

When compared to other PCTs nationally, Wolverhampton PCT spends lower and has marginally worse outcomes for Respiratory than the average for PCT in England

When compared to similar PCTs in their ONS cluster group Wolverhampton PCT have a low spend and significantly better outcome for Respiratory.

Wolverhampton PCT has an above average Asthma non-elective hospitalisation 28-day readmission rate compared with SHA/National/ONS cluster

Wolverhampton PCT has a lower 2009/10 rate for Asthma non-elective hospitalisation excess bed days than national/regional/ONS cluster rates

If the hospitalisation rate for COPD was reduced by 20% (the QIPP target), the associated savings would be £267.8k

There is variation between practices in the unplanned COPD admission rate (from 0.2 to 7.1 per 1000 registered individuals),

Wolverhampton City PCT could reduce their COPD hospital admissions by 20% (113 spells), if 19 GP practices reduced their

hospitalisation rate to the PCT average.

Wolverhampton City PCT could reduce their asthma hospital admissions by the QIPP target of 20% (84 spells), if 12 practices

reduced their admissions to the PCT average hospitalisation rate.


4.0 Spending on Health

Wolverhampton PCT spent £162.8 million per 100,000 of the population on health in 2009-10. This represents an increase of

approximately 13% from the £145.1m spent on health in 2008-9 and an increase from the £139.1m spent in 2007-8.

The total expenditure on Respiratory Disease in 2009-10 was £7.7m/100,000 population, compared to a National Average of £8.4m,

an SHA average of £8.2m and a cluster average of £8.6m. This means that Wolverhampton PCT’s expenditure on Respiratory

Disease is approx 7% less than the National / SHA and average.

Wolverhampton PCT is ranked 112/152 in terms of its spending on Respiratory Disease when compared to other PCT in England. A

full breakdown of Health spending by disease area for Telford and Wrekin PCT is given in Appendix 1.


5.0 Spend & Outcome

Department of Health Data prepared by the Yorkshire and Humber Public Health Authority show that in 2009/10 Wolverhampton PCT had a lower spend and worse outcome for Respiratory than the average for PCT in England, However it has a lower spend and significantly better outcomes than PCTs within its ONS cluster


6.0 Hospitalisation data

6.1 COPD non-elective hospitalisations per 1000 population

Wolverhampton PCT’s non-elective COPD hospitalisation rate was similar in 2009/10 than both the national and SHA averages,

having been also similar to both SHA and national averages for the previous two years(Figure 6.1)

The hospital admissions were 2.1 per 1000 population in 2007/08, 2.3 in 2008/09 and 2.2 in 2009/10

The 2009/10 hospitalisation rate was ranked 11/17 (with rank 1 being best) 10 in 2008/09, and 12 in 2007/08, and ranked

88/152 nationally in 2009/10 from 84 in 2008/09 and 2007/08 (see Appendix 5)

The 2009/10 hospitalisation rate was ranked 1/11, and also rank 1 in 2008/09 and 2007/08 in the Centres with Industry (B)

index (Appendix 15)

Figure 6.1. COPD non-elective hospitalisations per 1000 population

2.12.3 2.2

22.2 2.22.1

2.3 2.2

2.6

2.92.7

0

0.5

1

1.5

2

2.5

3

3.5

2007/08 2008/09 2009/10

National SHA Wolverhampton PCT Sub group


6.2 COPD non-elective hospitalisation costs per 1000 population

Wolverhampton PCT’s non-elective COPD hospitalisation costs were marginally higher than both the National and SHA

averages in 2009/10 having also been higher in 2007/08 and 2008/09 (Figure 6.2)

The hospital admission costs have risen in 2009/10 to £5,200 per 1000 population from £4,800 per 1000 population in 2008/09

from £4,600 in 2007/08

The 2009/10 hospitalisation costs was ranked 11/17 in the West Midlands, rank 11 in 2008/09 and was rank 12 in 2007/08, and

ranked 88/152 nationally in 2009/10, from rank 84 in 2008/09 and 2007/08 (see Appendix 6)

The 2009/10 hospitalisation cost was ranked 1/8 in the Centres with industry (B) index, rank 1 in 2008/09 and rank 2 in 2007/08

(see Appendix 16)

Figure 6.2: COPD non-elective hospitalisations costs (£k) per 1000 population

4.24.6

5.1

4.14.6

5.14.6 4.8

5.25.45.9

6.2

0

1

2

3

4

5

6

7

2007/08 2008/09 2009/10



6.3 COPD non-elective hospitalisation length of stay

Wolverhampton PCT’s non-elective COPD length of stay was higher than the SHA/national average in 2009/10 , and higher

than both the national and SHA averages in the preceding two years (Figure 6.3)

The average length of stay in 2009/10 was 8.1 days , down from 8.3 in 2008/09 and 9.3 in 2007/08

The 2009/10 average length of stay was ranked 11/17 in the West Midlands, from rank 10 in 2008/09 and rank 13 in 2007/08,

and ranked 100/152 nationally, from rank 93 in 2008/09 and rank 123 in 2007/08 (see Appendix 7)

The 2009/10 length of stay was ranked 6/8 in the Centres with industry (B) index, rank 5 in 2008/09 and 2007/08 (see Appendix

17)

Figure 6.3: COPD non-elective hospitalisations length of stay

8.38

7.78.4 8.2

7.9

9.3

8.3 8.18.4

7.8 7.9

0

1

2

3

4

5

6

7

8

9

10

2007/08 2008/09 2009/10



6.4 COPD non-elective hospitalisation 28-day readmission rate

Wolverhampton PCT’s non-elective COPD 28-day readmission rate was marginally lower than both the national and SHA

averages in 2009/10, and lower in 2008/09 and 2007/08 (Figure 6.4)

The 28-day readmission rate rose from 0.14 readmissions per spell in 2007/08 to 0.18 in 2008/09 and to 0.21 in 2009/10

The 2009/10 28-day readmission rate was ranked 8/17 in the West Midlands, down from rank 6 in 2008/09 and rank 1 in

2007/08, and ranked 54/152 nationally in 2010/09, down from rank 27 in 2008/09 and rank 5 in 2007/08 (see Appendix 8)

The 2009/10 28-day readmission rate ranked 1/8 in the Centres with industry (B) index, also rank 1 in 2008/09 and 2007/08

(see Appendix 18)

Figure 6.4: COPD non-elective hospitalisations 28-day readmission rate

0.20.21

0.22

0.190.21

0.22

0.14

0.18

0.210.210.23

0.24

0

0.05

0.1

0.15

0.2

0.25

0.3

2007/08 2008/09 2009/10



6.5 COPD non-elective hospitalisation excess bed days

Wolverhampton PCT’s non-elective COPD excess bed days was lower than the SHA/National averages in 2009/10, having

been higher in 2008/09 and 2007/08 (Figure 6.5)

The excess bed days have fallen from 0.9 days per spell in 2007/08, to 0.8 days per spell in 2008/09 and 0.6 days in 2009/10,

respectively

The 2009/10 excess bed days was ranked 8/17 in the West Midlands, rank 13 in 2008/09 and rank 11 in 2007/08, and ranked

77/152 nationally, rank 117 in 2008/09 and rank 105 in 2007/08 (see Appendix 9)

The 2009/10 non-elective hospitalisation excess bed days ranked 3/8 in the Centres with industry (B) index, was rank 5/11 in

2008/09 and rank 4 in 2007/08 (see Appendix 19)

Figure 6.5: COPD non-elective hospitalisations excess bed days

0.8

0.6

0.7

0.8

0.7

0.8

0.9

0.8

0.6

0.86

0.68

0.86

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

2007/08 2008/09 2009/10



6.6 COPD hospitalisation savings potential

Wolverhampton PCT’s 2009/10 non-elective COPD hospitalisation rate was 2.2 per 1000 population, equal with the national

average of 2.2 per 1000 population

Wolverhampton City PCT could reduce their COPD hospital admissions by 20% (113 spells), if 15 GP practices reduced their

hospitalisation rate to the PCT average.

If the hospitalisation rate were reduced by 10% or 20% (the QIPP target), the associated savings would be £133.9k and

£267.8k, respectively (see Appendix 25)


7.0 Asthma

7.1 Asthma non-elective hospitalisations per 1000 patients

Wolverhampton PCT’s 2009/10 non-elective Asthma hospitalisation rates were higher than the national average and than

the SHA average. It was also higher than both the national and SHA average in 2008/09 and 2007/08 respectively

The 2009/10 hospitalisation rate was 1.7 and 2008/09 and 1.6 in 2007/08

The 2009/10 hospitalisation rate was ranked 14/17 in the West Midlands, from 12 in 2008/09 and 13 in 2007/08, and ranked

136 nationally in 2009/10, from rank 126 in 2008/09 and was rank 130 in 2007/08 (see Appendix 10)

The 2009/10 hospitalisation rate was 4/8 in the Centres with industry (B) index, (Appendix 20), from rank 3 in 2008/09 and

rank 4 in 2007/08

Figure 7.1: Asthma non-elective hospitalisations per 1000 patients

1.21.3

1.21.3

1.51.4

1.61.7 1.7

1.6

1.91.8

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

2

2007/08 2008/09 2009/10



7.2 Asthma non-elective hospitalisation costs per 1000 patients

Wolverhampton PCT’s non-elective Asthma hospitalisation costs was higher than the SHA averages and higher than the

national average in 2009/10 , and higher than both in 2008/09 and also in 2007/08 (Figure 7.2)

The hospital admission costs per 1000 patients are £1,600 per 1000 population in 2009/10 ,and £1,500 in 2008/09 and 2007/08

The 2009/10 hospitalisation costs was ranked 13/17 in the West Midlands, 11/17 in 2008/09 and 12/17 in 2007/08, and ranked

132/152 nationally in 2009/10, rank 116 in 2008/09 and rank 133 in 2007/08 (see Appendix 11)

The 2009/10 hospitalisation costs was ranked 4/8 in the Centres with industry (B) index, (Appendix 21), was rank 3 in 2008/09

and rank 3 in 2007/08 (see Appendix 21)

Figure 7.2: Asthma non-elective hospitalisations costs (£k) per 1000 patients

1.11.2

1.11.2

1.4 1.41.5 1.5

1.61.5

1.7 1.7

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

2007/08 2008/09 2009/10



7.3 Asthma non-elective hospitalisation length of stay

Wolverhampton PCT’s non-elective Asthma length of stay was lower than both the national and SHA averages in 2009/10 and

in 2008/09 and equitable to the SHA/National averages in 2007/08 (Figure 7.3)

The average length of stay was 2.8 days in 2007/08, 2.5 days in 2008/09 and 2.5 days in 2009/10

The 2009/10 average length of stay was ranked 6/17 in the West Midlands compared with rank 5 in 2008/09 and rank 11 in

2007/08, and ranked 44/152 nationally in 2009/10, from rank 47 in 2008/09 and rank 77 in 2007/08 (see Appendix 12)

The 2009/10 length of stay was ranked 3/8 in the Centres with industry (B) index, (Appendix 22), from rank 2 in 2008/09 and

rank 4 in 2007/08 (see Appendix 22)

Figure 7.3: Asthma non-elective hospitalisations length of stay

2.8 2.8

2.7

2.8

2.7

2.6

2.8

2.5 2.5

3

2.8

2.5

2.2

2.3

2.4

2.5

2.6

2.7

2.8

2.9

3

3.1

2007/08 2008/09 2009/10



7.4 Asthma non-elective hospitalisation 28-day readmission rate

Wolverhampton PCT’s non-elective Asthma 28-day readmission rate was higher than both the national and SHA averages in

2009/10 from being similar than both averages in 2009/09 and 2007/08

The 28-day readmission rate was 0.14 readmissions per spell in 2009/10, 0.11 in 2008/09 and 0.10 readmissions per spell in

2007/08 respectively

The 2009/10 28-day readmission rate was ranked 14/17 in the West Midlands, compared with rank 11 in 2008/09 and rank 8 in

2007/08, and ranked 130/152 nationally, down from rank 82 in 2008/09 and was rank 75 in 2007/08 (see Appendix13 )

The 2009/10 28-day readmission rate was ranked 8/8 in the Centres with industry (B) index, (Appendix 23), down from rank 3 in

2008/09 and was rank 6 in 2007/08 (see Appendix 23)

Figure 7.4: Asthma non-elective hospitalisations 28-day readmission rate

0.10.11 0.110.11 0.11

0.12

0.10.11

0.14

0.08

0.110.12

0

0.02

0.04

0.06

0.08

0.1

0.12

0.14

0.16

2007/08 2008/09 2009/10



7.5 Asthma non-elective hospitalisation excess bed days

Wolverhampton PCT’s number of non-elective Asthma excess bed days was equivalent to the National average in 2009/10

from being lower in the preceding years (Figure 7.5)

The excess bed days stayed constant at 0.2 days per spell in 2009/10, 2008/09 and 2007/08.

The 2009/10 excess bed days rate was ranked 13/17 in the West Midlands, from rank 14 in 2008/09 and 2007/08, and ranked

114 nationally, from rank 111 in 2008/09 and rank 142 in 2007/08 (see Appendix 14)

The 2009/10 excess bed days was ranked 4/8 the Centres with industry (B) index, rank 2 in 2008/09 and rank 2 in 2007/08 (see

Appendix 24)

Figure 7.5: Asthma non-elective hospitalisations excess bed days

0.3 0.3

0.2

0.3 0.3 0.3

0.2 0.2 0.2

0.5

0.4

0.2

0

0.1

0.2

0.3

0.4

0.5

0.6

2007/08 2008/09 2009/10



7.6 Asthma hospitalisation savings potential

Wolverhampton PCT’s 2009/10 Asthma non-elective hospitalisations 28-day readmission rate was 0.14 in 2009/10 compared to

a National average of 0.11

Wolverhampton City PCT could reduce their asthma hospital admissions by approx 95% of the QIPP target of 20% (84 spells),

if 12 practices reduced their admissions to the PCT average hospitalisation rate.

If the hospitalisation rate were reduced by 10% and 20%, the associated savings would be £41k and £82k, respectively (see

Appendix 26)


8.0 GP practice COPD data

Figure 8.1 shows the variation in COPD non-elective hospitalisation rate by GP practice in Wolverhampton City PCT. Where no value

is presented, hospitalisation data was not available. Table 8.2 shows the 2009/10 spells, tariff and length of stay data for the GP

practices in Wolverhampton City PCT, along with the PCT averages for those performance indicators. The spells that would be

reduced if each practice was at the PCT average hospitalisation rate is also presented. Wolverhampton City PCT could reduce their

COPD hospital admissions by 20% (113 spells), if 15 GP practices reduced their hospitalisation rate to the PCT average.


Figure 8.1: COPD non-elective hospitalisations per 1000 population by GP practice

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Table 8.2: GP practice level COPD data for Wolverhampton City PCT

Practice Code Population Spells Spells per 1000

population Rank spells

Tariff per 1000 population

Rank tariff

Average LoS

Spells reduced if PCT average rate

Cumulative hosps reduced if PCT

average rate

PCT average 256543 563 2.2 4.8 8.1

M92649 2254 16 7.1 51 20.7 51 10.3 11 11

M92020 4165 22 5.3 50 10.8 47 3.5 13 24

M92619 1751 9 5.1 49 11.8 48 5.9 5 29

M92026 4089 21 5.1 48 12.0 49 10.9 12 41

M92041 5089 24 4.7 47 12.0 50 7.5 13 53

M92620 1752 8 4.6 46 8.6 43 3.1 4 57

M92019 6373 29 4.6 45 9.4 44 5.2 15 72

M92036 2174 8 3.7 44 7.1 38 3.5 3 75

M92638 2798 10 3.6 43 8.2 42 12.7 4 79

M92040 5585 19 3.4 42 7.4 39 4.8 6 85

M92003 2114 7 3.3 41 10.2 46 14.1 2 88

M92647 3088 10 3.2 40 7.6 40 4.7 3 91

M92630 4331 14 3.2 39 9.5 45 12.6 4 95

M92008 10608 34 3.2 38 6.3 32 6.1 10 105

M92012 9277 29 3.1 37 6.9 35 8.1 8 113

M92027 3959 12 3.0 36 7.0 37 6.7 3 116

M92001 3617 10 2.8 35 6.9 34 3.9 2 118

M92629 2968 8 2.7 34 5.9 30 5.3 1 120

M92609 4511 12 2.7 33 7.0 36 13.4 2 122

M92009 10009 25 2.5 32 6.6 33 7.7 3 124

M92002 8427 21 2.5 31 5.4 26 7.2 2 126


M92013 5259 13 2.5 30 5.3 25 5.5 1 127

M92627 3005 7 2.3 29 5.7 29 4.7 0 128

M92015 4594 10 2.2 28 5.6 28 13.8 - -

M92014 2303 5 2.2 27 5.0 23 12.8 - -

M92637 1874 4 2.1 26 3.8 17 2.3 - -

M92024 12288 26 2.1 25 4.6 22 7 - -

M92022 3120 6 1.9 24 2.9 14 2 - -

M92004 3132 6 1.9 23 5.9 31 12.3 - -

M92607 11716 22 1.9 22 5.3 24 12.6 - -

M92030 6611 12 1.8 21 4.1 19 8.4 - -

M92029 4409 8 1.8 20 8.0 41 12.5 - -

M92016 2343 4 1.7 19 5.4 27 17.5 - -

M92611 4731 8 1.7 18 2.6 12 6.5 - -

M92028 9063 14 1.5 17 4.2 21 7.9 - -

M92011 11295 17 1.5 16 4.1 20 11.3 - -

M92043 5517 7 1.3 15 2.9 13 6.9 - -

M92010 11882 15 1.3 14 3.8 18 14.3 - -

M92610 2434 3 1.2 13 2.5 11 3.3 - -

M92006 5012 6 1.2 12 3.0 15 9.2 - -

M92007 6802 8 1.2 11 3.7 16 10.1 - -

M92654 2188 2 0.9 10 2.3 10 2 - -

M92039 2986 2 0.7 9 1.7 8 3 - -

M92042 3266 2 0.6 8 1.3 6 7 - -

M92640 2231 1 0.4 7 1.6 7 31 - -

M92017 2725 1 0.4 6 0.9 4 1 - -

M92035 3104 1 0.3 5 0.9 3 7 - -

M92643 3125 1 0.3 4 0.2 1 1 - -

M92612 3394 1 0.3 3 2.0 9 9.5 - -


M92031 7263 2 0.3 2 1.1 5 15.3 - -

M92044 4122 1 0.2 1 0.6 2 13 - -

M92021 2363 - 0.0 - - - - - -

M92023 1687 - 0.0 - - - - - -

M92631 1461 - 0.0 - - - - - -

M92642 2169 - 0.0 - - - - - -

M92644 2180 - 0.0 - - - - - -


9.0 GP practice asthma data

Figure 9.1 shows the variation in asthma non-elective hospitalisation rate by GP practice in Wolverhampton City PCT. Where no value

is presented, hospitalisation data was not available Table 9.2 shows the 2009/10 spells, tariff and length of stay data for the GP

practices in Wolverhampton City PCT, along with the PCT averages for those performance indicators. The spells that would be

reduced if each practice was at the PCT average hospitalisation rate is also presented. Wolverhampton City PCT could reduce their

asthma hospital admissions by 95% of the QIPP target of 20% (84 spells), if 12 practices reduced their admissions to the PCT

average hospitalisation rate.


Figure 9.1: Asthma non-elective hospitalisations per 1000 population by GP practice

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1M

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3


Table 9.2: GP practice level Asthma data for Wolverhampton City PCT

Practice Code Population Spells Spells per 1000

population Rank spells

Tariff per 1000 population

Rank tariff

Average LoS

Spells reduced if PCT average rate

Cumulative hosps reduced if PCT

average rate

PCT average 256543 419 1.7 1.5 2.5

M92610 2434 10 4.1 45 3.1 44 1 6 6

M92026 4089 15 3.7 44 3.0 42 1.4 8 14

M92044 4122 14 3.4 43 2.7 41 1.7 7 21

M92019 6373 18 2.8 42 2.2 36 2.2 7 28

M92036 2174 6 2.8 41 2.5 40 1.5 2 30

M92006 5012 13 2.6 40 2.0 32 1.4 4 35

M92017 2725 7 2.6 39 1.8 30 1.4 2 37

M92011 11295 28 2.5 38 3.1 43 0.9 9 46

M92607 11716 29 2.5 37 2.3 38 2.7 9 55

M92013 5259 13 2.5 36 3.2 45 4.2 4 59

M92043 5517 13 2.4 35 2.2 37 2.5 4 63

M92031 7263 17 2.3 34 2.1 34 2.1 5 67

M92611 4731 11 2.3 33 2.1 33 1.9 3 70

M92009 10009 22 2.2 32 2.3 39 3.5 5 75

M92002 8427 17 2.0 31 1.6 24 2 3 78

M92020 4165 8 1.9 30 1.5 20 1.3 1 79

M92007 6802 13 1.9 29 1.7 26 2.8 1 80

M92029 4409 8 1.8 28 1.8 29 5 1 81

M92040 5585 10 1.8 27 2.1 35 3.7 1 81

M92015 4594 8 1.7 26 1.6 25 4 0 82

M92619 1751 3 1.7 25 1.1 12 1 0 82


M92637 1874 3 1.6 24 1.7 27 4.7 - -

M92041 5089 8 1.6 23 1.2 13 1.4 - -

M92028 9063 14 1.5 22 1.6 23 2.6 - -

M92027 3959 6 1.5 21 1.5 22 2.5 - -

M92030 6611 10 1.5 20 1.5 21 2.6 - -

M92012 9277 14 1.5 19 1.3 14 2 - -

M92024 12288 18 1.5 18 1.4 16 2.9 - -

M92003 2114 3 1.4 17 2.0 31 4 - -

M92654 2188 3 1.4 16 1.7 28 6.5 - -

M92649 2254 3 1.3 15 1.5 19 4.7 - -

M92014 2303 3 1.3 14 1.4 17 6.5 - -

M92016 2343 3 1.3 13 1.4 15 5 - -

M92629 2968 3 1.0 12 0.9 9 3.3 - -

M92039 2986 3 1.0 11 0.7 4 0 - -

M92627 3005 3 1.0 10 0.8 8 2.3 - -

M92035 3104 3 1.0 9 1.4 18 6.5 - -

M92004 3132 3 1.0 8 0.8 6 2 - -

M92042 3266 3 0.9 7 0.9 10 2 - -

M92612 3394 3 0.9 6 0.8 5 3.3 - -

M92008 10608 9 0.8 5 0.8 7 3 - -

M92001 3617 3 0.8 4 1.1 11 5 - -

M92010 11882 9 0.8 3 0.6 3 1.4 - -

M92630 4331 3 0.7 2 0.5 1 1 - -

M92609 4511 3 0.7 1 0.6 2 2 - -

M92021 2363 - 0.0 - - - - - -

M92023 1687 - 0.0 - - - - - -

M92631 1461 - 0.0 - - - - - -

M92642 2169 - 0.0 - - - - - -


M92644 2180 - 0.0 - - - - - -

M92620 1752 - 0.0 - - - - - -

M92638 2798 - 0.0 - - - - - -

M92647 3088 - 0.0 - - - - - -

M92022 3120 - 0.0 - - - - - -

M92640 2231 - 0.0 - - - - - -

M92643 3125 - 0.0 - - - - - -


10.0 Comparisons of COPD & Asthma Admission Rates

Figure 10.1 collates the non-elective hospitalisation rates for both COPD and asthma in Wolverhampton City PCT.

Figure 10.1: COPD and asthma non-elective hospitalisations per 1000 population by GP practice

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COPD

Asthma


11.0 COPD & Asthma Prevalence Data

Figure 11.1 Wolverhampton City COPD Prevalence from QOFF Register 2008/9

0.0%

0.5%

1.0%

1.5%

2.0%

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Figure 11.2 Wolverhampton City Asthma Prevalence from QOFF register 2008/9

0.0%

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Figure 11.3 Combined Asthma and COPD Prevalence Wolverhampton City PCT 2008/9

0.0%

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Appendix 1: Wolverhampton PCT Health Expenditure


0

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3

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6

7

8

9

10Spend on Respiratory 2009-10

£m per 100,000 population

Appendix 2: Wolverhampton PCT Spend on Respiratory versus other PCT in SHA


Appendix 3: Wolverhampton Spend Versus Outcome, Right Care Analysis


Appendix 4: Wolverhampton QOF Data 2009/10

Indicators

The light grey bar shows the range of values found in England. The dark grey sections mark out the

range within which the middle-half of the observed values lie (25th to 75th percentile). The red line shows where the England average is. The position of the dot shows the

practice value, a diamond the PCT value, a triangle the cluster value in relation to this scale. The corresponding numbers can be found in the cells next to the chart.Note: This

type of chart requires a value judgement if high is good or bad. Not for all indicators it is possible to do this in an indisputable and meaningful way. The practice values are

colour-coded:

Significantly worse than regional average

Not significantly different from regional average

Significantly better than regional average

o Significance level not calculated

PCT value

Cluster value


Appendix 5: West Midlands non-elective COPD hospitalisation data

Ranking based on per 1000 population data

PCT 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10

National 2.1 2.3 2.2 146 155 140 - - - - - -

SHA 2.0 2.2 2.2 147 154 143 - - - - - -

Herefordshire PCT 1.5 1.5 1.4 117 109 98 1 1 1 23 16 22

Heart Of Birmingham Teaching PCT 1.6 1.6 1.5 229 237 215 4 2 2 31 23 27

Warwickshire PCT 1.6 1.6 1.6 133 126 119 5 3 3 35 30 36

Shropshire County PCT 1.7 1.8 1.7 110 118 108 6 5 4 45 44 42

Telford and Wrekin PCT 2.0 2.3 1.8 127 134 101 9 9 5 74 79 49

Worcestershire PCT 1.5 1.9 1.8 122 147 130 3 6 6 30 54 52

South Staffordshire PCT 1.5 1.7 1.8 109 121 127 2 4 7 24 36 55

North Staffordshire PCT 2.1 2.1 2.0 128 122 108 10 8 8 82 73 70

Solihull Care Trust 2.0 2.4 2.1 139 164 136 8 12 9 73 89 77

Dudley PCT 2.1 2.4 2.2 160 169 149 11 11 10 83 87 86

Wolverhampton City PCT 2.1 2.3 2.2 156 162 149 12 10 11 84 84 88

South Birmingham PCT 2.3 2.6 2.4 151 167 150 13 13 12 94 100 96

Coventry Teaching PCT 1.9 2.1 2.4 135 142 156 7 7 13 71 72 98

Sandwell PCT 2.8 3.0 2.7 170 176 157 14 14 14 119 117 115

Walsall Teaching PCT 3.0 3.0 2.7 194 181 153 17 16 15 129 119 116

Birmingham East and North PCT 2.9 3.1 3.0 212 226 210 15 17 16 122 123 124

Stoke On Trent PCT 3.0 3.0 3.3 163 162 166 16 15 17 125 118 133

National rankCOPD admissions per 1000 population Rank within SHACOPD admissions per 1000 registered pts


Appendix 6: West Midlands non-elective COPD hospitalisation costs


PCT 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10

National 4.2 4.6 5.1 297 314 329 - - - - - -

SHA 4.1 4.6 5.1 297 315 336 - - - - - -










Dudley PCT 4.0 4.3 5.0 298 303 334 8 8 10 68 67 73




Sandwell PCT 5.5 5.7 6.2 332 332 358 15 14 14 116 111 110




COPD tariff per 1000 population COPD tariff per 1000 registered pts Rank within SHA National rank


Appendix 7: West Midlands non-elective COPD hospitalisation length of stay

PCT 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10

National 8.3 8.0 7.7 - - - - - -

SHA 8.4 8.2 7.9 - - - - - -

Solihull Care Trust 8.2 8.5 6.7 7 11 1 62 98 23

North Staffordshire PCT 8.7 7.2 6.8 10 4 2 101 34 27

Heart Of Birmingham Teaching PCT 8.7 7.8 7.2 11 9 3 102 62 46

Stoke On Trent PCT 7.4 7.1 7.3 5 3 4 30 29 51

Herefordshire PCT 8.4 7.7 7.4 8 7 5 73 58 55

Birmingham East and North PCT 9.5 9.1 7.6 14 13 6 130 130 65

Telford and Wrekin PCT 6.9 7.5 7.7 1 6 7 17 49 74

Dudley PCT 7.3 6.9 7.8 4 2 8 28 26 77

Sandwell PCT 7.2 6.6 7.9 3 1 9 23 21 91

Walsall Teaching PCT 8.6 9.7 8.1 9 17 10 87 142 97

Wolverhampton City PCT 9.3 8.3 8.1 13 10 11 123 93 100

Shropshire County PCT 9.7 9.4 8.2 17 16 12 139 138 102

South Staffordshire PCT 7.5 7.3 8.2 6 5 13 37 38 104

Worcestershire PCT 7.1 7.7 8.2 2 7 14 22 58 105

Coventry Teaching PCT 9.6 9.1 8.3 16 12 15 136 129 109

Warwickshire PCT 9.1 9.2 8.9 12 14 16 117 134 132

South Birmingham PCT 9.6 9.4 9.4 15 15 17 133 136 144

National rankCOPD Length of stay Rank within SHA


Appendix 8: West Midlands non-elective COPD hospitalisation 28-day readmission rate

PCT 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10

National 0.20 0.21 0.22 - - - - - -

SHA 0.19 0.21 0.22 - - - - - -










Dudley PCT 0.15 0.16 0.22 4 2 10 18 7 66





Sandwell PCT 0.19 0.22 0.24 7 13 15 62 93 106



COPD readmissions per spell Rank within SHA National rank


Appendix 9: West Midlands non-elective COPD hospitalisation excess bed days per spell

PCT 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10

National 0.8 0.6 0.7 - - - - - -

SHA 0.8 0.7 0.8 - - - - - -












Dudley PCT 0.5 0.2 0.8 6 1 12 38 8 110





Sandwell PCT 0.4 0.3 1.3 3 2 17 21 26 140

COPD excess bed days per spell Rank within SHA National rank


Appendix 10: West Midlands non-elective asthma hospitalisation data


PCT 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10

National 1.2 1.3 1.2 81 86 77 - - - - - -

SHA 1.3 1.5 1.4 93 103 96 - - - - - -





Dudley PCT 1.0 1.0 1.1 76 72 71 5 4 5 52 36 60










Sandwell PCT 1.8 2.0 1.9 106 115 108 15 15 15 140 142 143



Asthma admissions per 1000 population Asthma admissions per 1000 registered pts Rank within SHA National rank


Appendix 11: West Midlands non-elective asthma hospitalisation costs


PCT 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10

National 1.1 1.2 1.1 74 79 74 - - - - - -

SHA 1.2 1.4 1.4 86 94 92 - - - - - -





Dudley PCT 0.8 0.8 1.0 61 56 66 4 2 5 26 12 49










Sandwell PCT 1.6 1.8 1.7 97 104 100 14 15 15 142 141 142



Asthma tariff per 1000 population Asthma tariff per 1000 registered pts Rank within SHA National rank


Appendix 12: West Midlands non-elective asthma hospitalisation length of stay

PCT 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10

National 2.8 2.8 2.7 - - - - - -

SHA 2.8 2.7 2.6 - - - - - -








Dudley PCT 2.3 2.0 2.3 5 2 2 23 5 23

Sandwell PCT 2.6 2.7 2.3 8 8 2 56 67 23









Asthma Length of stay Rank within SHA National rank


Appendix 13: West Midlands non-elective asthma hospitalisation 28-day readmission rate

PCT 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10

National 0.10 0.11 0.11 - - - - - -

SHA 0.11 0.11 0.12 - - - - - -

Dudley PCT 0.10 0.07 0.09 9 2 1 81 12 33







Sandwell PCT 0.13 0.09 0.12 16 6 8 138 39 97










Asthma readmissions per spell Rank within SHA National rank


Appendix 14: West Midlands non-elective asthma hospitalisation excess bed days per spell


PCT 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10

National 0.3 0.3 0.2 - - - - - -

SHA 0.3 0.3 0.3 - - - - - -






Sandwell PCT 0.3 0.2 0.1 11 7 6 78 45 60


Dudley PCT 0.1 0.1 0.2 1 2 8 6 7 74










Asthma excess bed days per spell Rank within SHA National rank


Appendix 15: Centres with Industry (B) non-elective COPD hospitalisation data


PCT 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10

National 2.1 2.3 2.2 146 155 140 - - -

SHA 2.0 2.2 2.2 147 154 143 - - -



Nottingham City PCT 2.8 3.0 2.4 198 203 169 7 4 3

Barking and Dagenham PCT 2.6 3.2 2.6 236 279 209 4 7 4

Leicester City PCT 2.5 2.6 2.7 220 223 232 3 2 5

Sandwell PCT 2.8 3.0 2.7 170 176 157 6 5 6

Manchester PCT 2.8 3.2 2.9 151 170 154 5 8 7


COPD admissions per 1000 population Rank within sub-groupCOPD admissions per 1000 registered pts


Appendix 16: Centres with Industry (B) non-elective COPD hospitalisation costs


PCT 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10

National 4.2 4.6 5.1 297 314 329 - - -

SHA 4.1 4.6 5.1 297 315 336 - - -






Sandwell PCT 5.5 5.7 6.2 332 332 358 4 5 6


Manchester PCT 5.8 6.4 7.3 315 336 385 7 6 8

COPD tariff per 1000 population COPD tariff per 1000 registered pts Rank within sub-group


Appendix 17: Centres with Industry (B) non-elective COPD hospitalisation length of stay

PCT 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10

National 8.3 8.0 7.7 - - -

SHA 8.4 8.2 7.9 - - -

Nottingham City PCT 6.3 5.9 6.3 1 1 1

Leicester City PCT 7.3 7.1 7.1 3 3 2

Barking and Dagenham PCT 8.6 7.6 7.2 4 4 3

Birmingham East and North PCT 9.5 9.1 7.6 7 7 4

Sandwell PCT 7.2 6.6 7.9 2 2 5

Wolverhampton City PCT 9.3 8.3 8.1 5 5 6

South Birmingham PCT 9.6 9.4 9.4 8 8 7

Manchester PCT 9.4 8.5 9.6 6 6 8

COPD Length of stay Rank within sub-group


Appendix 18: Centres with Industry (B) non-elective COPD hospitalisation 28-day readmission rate

PCT 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10

National 0.20 0.21 0.22 - - -

SHA 0.19 0.21 0.22 - - -



Sandwell PCT 0.19 0.22 0.24 2 2 3




Manchester PCT 0.25 0.26 0.25 7 8 7


COPD readmissions per spell Rank within sub-group


Appendix 19: Centres with Industry (B) non-elective COPD hospitalisation excess bed days per spell

PCT 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10

National 0.8 0.6 0.7 - - -

SHA 0.8 0.7 0.8 - - -







Sandwell PCT 0.4 0.3 1.3 2 2 7


COPD excess bed days per spell Rank within sub-group


Appendix 20: Centres with Industry (B) non-elective asthma hospitalisation data


PCT 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10

National 1.2 1.3 1.2 81 86 77 - - -

SHA 1.3 1.5 1.4 93 103 96 - - -





Sandwell PCT 1.8 2.0 1.9 106 115 108 7 6 5

Manchester PCT 1.7 1.9 1.9 92 100 101 5 5 6



Asthma admissions per 1000 population Asthma admissions per 1000 registered pts Rank within sub-group


Appendix 21: Centres with Industry (B) non-elective asthma hospitalisation costs


PCT 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10

National 1.1 1.2 1.1 74 79 74 - - -

SHA 1.2 1.4 1.4 86 94 92 - - -





Sandwell PCT 1.6 1.8 1.7 97 104 100 5 5 5

Manchester PCT 1.6 1.8 1.8 86 96 96 4 6 6



Asthma tariff per 1000 population Asthma tariff per 1000 registered pts Rank within sub-group


Appendix 22: Centres with Industry (B) non-elective asthma hospitalisation length of stay

PCT 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10

National 2.8 2.8 2.7 - - -

SHA 2.8 2.7 2.6 - - -


Sandwell PCT 2.6 2.7 2.3 2 5 2







Asthma Length of stay Rank within sub-group


Appendix 23: Centres with Industry (B) non-elective asthma hospitalisation 28-day readmission rate

PCT 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10

National 0.10 0.11 0.11 - - -

SHA 0.11 0.11 0.12 - - -



Manchester PCT 0.09 0.11 0.10 3 4 3

Sandwell PCT 0.13 0.09 0.12 8 1 4





Asthma readmissions per spell Rank within sub-group


Appendix 24: Centres with Industry (B) non-elective asthma hospitalisation excess bed days per spell

PCT 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10

National 0.3 0.3 0.2 - - -

SHA 0.3 0.3 0.3 - - -



Sandwell PCT 0.3 0.2 0.1 3 3 3






Asthma excess bed days per spell Rank within sub-group


Appendix 25: COPD hospitalisation savings potential

PCT PopulationCOPD

Register

COPD

admissions

COPD admissions

per 1000 population

Cost per

spell (£)

Admissions reduced

if average

Savings if average

admissions (£)

Savings if

admissions -10% (£)

Savings if


National 54,003,337 829,767 116,130 2.2 2,350 0 0 27,286,400 54,572,800

SHA 5,707,214 86,020 12,299 2.2 2,350 26 61,292 2,890,700 5,781,400

Herefordshire PCT 180,142 2,649 259 1.4 2,436 0 0 63,100 126,200

Heart Of Birmingham Teaching PCT 313,934 2,218 476 1.5 2,288 0 0 108,900 217,800

Warwickshire PCT 546,003 7,527 899 1.6 2,488 0 0 223,700 447,400

Shropshire County PCT 295,342 4,688 504 1.7 2,222 0 0 112,000 224,000

Telford and Wrekin PCT 169,429 2,996 304 1.8 2,342 0 0 71,200 142,400

Worcestershire PCT 572,989 7,993 1,038 1.8 2,318 0 0 240,600 481,200

South Staffordshire PCT 605,435 8,726 1,112 1.8 2,511 0 0 279,200 558,400

North Staffordshire PCT 208,582 3,846 414 2.0 2,222 0 0 92,000 184,000

Solihull Care Trust 220,953 3,400 463 2.1 2,281 0 0 105,600 211,200

Dudley PCT 312,366 4,631 692 2.2 2,238 20 45,398 154,900 309,800

Wolverhampton City PCT 256,543 3,848 575 2.2 2,329 23 54,315 133,900 267,800

South Birmingham PCT 386,532 6,122 918 2.4 2,461 87 213,578 225,900 451,800

Coventry Teaching PCT 349,333 5,420 846 2.4 2,346 95 222,401 198,500 397,000

Sandwell PCT 322,378 5,612 883 2.7 2,277 190 432,151 201,100 402,200

Walsall Teaching PCT 266,448 4,773 731 2.7 2,488 158 393,223 181,900 363,800

Birmingham East and North PCT 424,787 6,059 1,270 3.0 2,350 357 837,982 298,500 597,000

Stoke On Trent PCT 276,018 5,512 915 3.3 2,183 321 701,557 199,700 399,400


Appendix 26: Asthma hospitalisation savings potential

PCT PopulationAsthma

Register

Asthma

admissions

Asthma admissions

per 1000 population

Cost per

spell (£)

Admissions reduced

if average

Savings if average

admissions (£)

Savings if


Savings if


National 54,003,337 3,180,080 63,590 1.2 967 0 0 6,149,600 12,299,200

SHA 5,707,214 348,023 8,268 1.4 959 0 0 793,200 1,586,400

Shropshire County PCT 295,342 19,203 239 0.8 958 0 0 22,900 45,800

Herefordshire PCT 180,142 11,634 147 0.8 932 0 0 13,700 27,400

Warwickshire PCT 546,003 34,752 506 0.9 1,030 0 0 52,100 104,200

Worcestershire PCT 572,989 34,768 575 1.0 915 0 0 52,600 105,200

Dudley PCT 312,366 18,417 330 1.1 924 0 0 30,500 61,000

North Staffordshire PCT 208,582 13,647 227 1.1 960 0 0 21,800 43,600

South Staffordshire PCT 605,435 34,509 708 1.2 958 0 0 67,800 135,600

Walsall Teaching PCT 266,448 16,027 346 1.3 1,014 32 32,718 35,100 70,200

Telford and Wrekin PCT 169,429 10,557 227 1.3 930 27 25,556 21,100 42,200

Solihull Care Trust 220,953 13,206 321 1.5 956 61 58,171 30,700 61,400

Coventry Teaching PCT 349,333 20,658 539 1.5 1,059 128 135,232 57,100 114,200

South Birmingham PCT 386,532 24,110 627 1.6 933 172 160,339 58,500 117,000

Stoke On Trent PCT 276,018 17,741 450 1.6 942 125 117,762 42,400 84,800

Wolverhampton City PCT 256,543 14,973 436 1.7 940 134 125,930 41,000 82,000

Sandwell PCT 322,378 20,397 604 1.9 929 224 208,418 56,100 112,200

Birmingham East and North PCT 424,787 25,479 944 2.2 892 444 395,851 84,200 168,400

Heart Of Birmingham Teaching PCT 313,934 17,945 1,042 3.3 1,013 672 681,370 105,600 211,200

wolverhampton city pct copd & asthma benchmarking data...wolverhampton pct’s 2009/10...

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